Retinal Pigment Epithelial Detachment After Scleral Buckling For Rhegmatogenous Retinal Detachment

[Objective]:Rhegmatogenous retinal detachment (RRD) is a potentially blinding ophthalmic pathology caused by a separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE) and the accumulation of fluid within this potential space. The basic principle for RRD surgical treatment is localizing and sealing retinal breaks. With the introduction of scleral buckling, intraocular gas injection, and pars plana vitrectomy, the history of RRD repairing has greatly changed. Even more difficult cases of RRD can now be operated on with these advances in techniques and technology. In many vitreoretinal surgical centres, the use of scleral buckling constitutes the mainstay of treatment for RRD, either alone for routine uncomplicated cases or combined with vitrectomy in patients with more advanced forms of the disease.Complications associated with sckeral buckling, such as refractive changes, diplopia, macula edema, explant extrusion, proliferative vitreoretinopathy (PVR), or infection et al, have been noted. We report here a series of complications after scleral buckling, among which 17 RPE detachments after scleral buckling are described and we attempt to find out the possible causes, in order to explore potential prevent and treatment recommendations.[Methods]:1.Cases:109 eyes of 107 patients affected by RRD and referred to our ophthalmologic department from July 2008 to October 2009 were retrospectively considered. Each patient underwent a scleral buckling. The 107 patients ranged in age from 9 to 78 years at the beginning of the study. Fifty one were men and fifty-six women.2.Surgery classification:according to the way of compression:(A1) 18 cases of scleral encircling procedures, (A2) 53 cases of scleral buckling with radial explants, (A3) 38 cases of scleral buckling with circumferential explants.According to whether drain the subretinal fluid or not:(B1) draining 95 cases, (B2) not draining 14 cases.3.Postoperative follow-up:Each patient underwent an ophthalmological examination including pupils dilated fundus examination, corrected visual acuity 0.5 month,1.5 months,3 months, and 6 months after surgical therapy, along with ophthalmology B-type ultrasonography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) results intermittently presented and discussed. The patients diagnosed as RPE detachment received glucocorticoids as the treatment. We use SPSS (Statistics 17.0) software package to analyze whether the prevalence of RPE detachment has statistical differences in age, gender, or surgical modes, and to evaluate the therapeutic effect of glucocorticoids.[Results]:The 107 patients ranged in age from 9 to 78 years at the beginning of the study (median 48.0000). Fifty one were men and fifty-six women. Preoperative visual acuity:＜0.3,78 eyes; 0.3～0.6,27 eyes;＞0.6,4 eyes. According to the PVR grading standards (1983):Grade A,24 eyes; Grade B,41 eyes; Grade C1,30 eyes; Grade C2,14 eyes.There are 12 cases of retinal neuroepithelial detachment in 0.5 month after surgery, but the retinal reattachment was achieved in all cases after 6 months' follow-up. Five eyes were diagnosed with macular epiretinal membrane, while the number of macula edema, refractive changes is 19 and 49 respectively.17 cases of RPE detachments after scleral buckling were detected, verified by clinical findings, OCT, FFA and ICGA. According to the statistic analysis:The patients, who developed RPE detachment, is younger than the total (median=30.0000, p=0.000＜0.05). The scleral buckling with circumferential explants is at higher risk than the radial ones (p=0.001＜0.0125), while not draining the subretinal fluid exposes more danger to our patients (p=0.001＜0.05). After glucocorticoids therapy, the patients' visual acuity has obtained somewhat elevation.[Conclusions]:RPE detachments may develop after scleral buckling due to some inflammatory or ischemic factors. It is more prevalent among young adulthoods, especially for those who received circumferential scleral buckling or subretinal fluid non-drainage. According to our experience, the application of glucocorticoids therapy may get a certain effect.